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Williams JL, Keaton K, Phillips RW, Crossley AR, Glenn JM, Gleason VL. Changes in Health Care Utilization and Associated Costs After Supportive Housing Placement by an Urban Community Mental Health Center. Community Ment Health J 2023; 59:1578-1587. [PMID: 37247121 PMCID: PMC10226018 DOI: 10.1007/s10597-023-01146-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 05/18/2023] [Indexed: 05/30/2023]
Abstract
Permanent supportive housing (PSH) for individuals experiencing homelessness and living with mental illness can reduce utilization of crisis care services and increase utilization of outpatient care, although the extent to which pre-housing utilization patterns influence post-housing utilization remains unclear. Therefore, pre- and post-housing health service utilization was examined in 80 individuals living with a chronic mental illness who were and were not utilizing health care services in the years pre- and post-housing. Overall, the proportion of tenants utilizing outpatient services, including outpatient behavioral health services, increased from pre- to post-housing. Tenants who did not use outpatient behavioral health services prior to housing were disproportionately less likely than their peers to use those services after being housed. Among tenants who utilized crisis care services prior to being housed, reductions were observed in the number of crisis care visits. Results suggest PSH leads to changes in health care utilization and associated costs.
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Affiliation(s)
- Joah L Williams
- Department of Psychology, University of Missouri, Kansas City, MO, USA.
- University Health, Kansas City, MO, USA.
| | - Kim Keaton
- Corporation for Supportive Housing, New York, NY, USA
| | | | | | | | - Vivian L Gleason
- Department of Psychology, University of Missouri, Kansas City, MO, USA
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2
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Tsai J, Kelton K. Service use and barriers to care among homeless veterans: Results from the National Veteran Homeless and Other Poverty Experiences (NV-HOPE) study. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:507-515. [PMID: 35748189 DOI: 10.1002/jcop.22912] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/22/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
The objective of this study was to examine type of services U.S. veterans seek when they experience homelessness, characteristics associated with service use, and reasons for not using services. Data from a 2021 nationally representative survey of 1004 low-income U.S. veterans were analyzed with descriptive and multivariable analyses. One-quarter of low-income U.S. veterans with experiences of homelessness reported using homeless services while they were homeless and about 27% reported using U.S. Department of Veterans Affairs (VA) healthcare or benefits while homeless. Black and Hispanic veterans were more likely to use both homeless services and VA services while homeless than veterans of other race/ethnic groups. The most common barriers to services were: veterans felt they did not need help, they did not have information about services, there was stigma and shame, and transportation barriers were encountered. These findings suggest veterans use various VA and community-based homeless and healthcare services, but they do experience barriers that may be improved with better public information and care coordination to improve service uptake among homeless veterans.
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Affiliation(s)
- Jack Tsai
- U.S. Department of Veterans Affairs, National Center on Homelessness among Veterans, Tampa, Florida, USA
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Katherine Kelton
- U.S. Department of Veterans Affairs, National Center on Homelessness among Veterans, Tampa, Florida, USA
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
- South Central Mental Illness Research Education and Clinical Center (MIRECC), Houston, TX, USA
- South Texas Veterans Health Care System, San Antonio Geriatric Research Education and Clinical Center (GRECC), San Antonio, TX, USA
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3
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The Health Needs of Regionally Based Individuals Who Experience Homelessness: Perspectives of Service Providers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148368. [PMID: 35886228 PMCID: PMC9316847 DOI: 10.3390/ijerph19148368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 12/07/2022]
Abstract
The bidirectional relationship between homelessness and poor health and the barriers that individuals who experience homelessness face when trying to access healthcare are well documented. There is, however, little Australian research exploring the situation of individuals who experience homelessness in regional contexts and, moreover, from the perspective of service providers. A qualitative descriptive methodology underpinned this study, with in-depth semi-structured interviews being conducted with 11 service providers to identify barriers to care faced by people who experience homelessness and barriers that service providers themselves experience in supporting this population. The key barriers identified were client-level barriers: living day-by-day, financial, health literacy, mental health conditions, behaviour, safety and stigma; provider-level barriers: few bulk-billing doctors, fragmented services, limited resources, negative past experiences with healthcare; and system level barriers: transportation, over-stretched healthcare services. The combined impact of these barriers has significantly contributed to the desperate situation of people experiencing homelessness in Launceston. This situation is likely replicated in other regional populations in Australia. Given that individuals experiencing homelessness have higher rates of every measure in health inequality, steps need to be taken to reduce barriers, and a standardised approach to health care urgently needs to be implemented by governments at the state and national level to improve the health of regionally based individuals experiencing homelessness.
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Pruitt AS, Barile JP. Actionable research for understanding and addressing homelessness. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:2051-2057. [PMID: 35545867 DOI: 10.1002/jcop.22878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
Homelessness results from an interaction of structural determinants and individual vulnerabilities, creating various pathways into homelessness and having multilevel impacts. Understanding and addressing homelessness requires research that not only takes an ecological perspective but also can be translated into action. Despite research demonstrating differing needs and experience among various subpopulations, particularly marginalized groups, homeless service systems often take a one-size-fits-all approach. Additionally, homeless service systems' prioritization of the most vulnerable and chronically homeless for permanent housing programs results in a service system that operates in a state of triage, with minimal attention to prevention efforts. This special issue highlights actionable research focused on preventing homelessness and addressing disparities among marginalized groups. Included articles target homelessness at multiple levels using a combination of qualitative, quantitative, and mixed-methods approaches. Embedded in community psychology values, this study focuses on prevention, leverages participatory methods, relies on diverse lived experiences, and explores community-based solutions.
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Affiliation(s)
- Anna S Pruitt
- University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | - John P Barile
- University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
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Chiaramonte D, Clements KA, López‐Zerón G, Ayeni OO, Farero AM, Ma W, Sullivan CM. Examining contextual influences on the service needs of homeless and unstably housed domestic violence survivors. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:1831-1853. [PMID: 34146356 PMCID: PMC8684560 DOI: 10.1002/jcop.22637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 06/12/2023]
Abstract
Domestic violence (DV) is a leading cause of homelessness for women, yet many DV agencies are just beginning to focus on helping clients stabilize their housing situations. The purpose of this study was to better understand the contexts and service needs of unstably housed and homeless DV survivors, to promote more efficient and successful service matching from DV agencies. We examined whether DV survivors could be grouped by particular features, histories, and contextual factors, and how these group differences impacted what they needed from DV agencies. The sample included 406 homeless and unstably housed DV survivors who had recently sought DV services. Latent class analysis supported the identification of four distinct classes: (1) highest disadvantages service seeker, (2) moderate disadvantages-criminal legal system service seeker, (3) moderate disadvantages service seeker, and (4) lower disadvantages service seeker. Additionally, we were able to profile each class, and test the types of services survivors in each class needed from agencies.
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Affiliation(s)
- Danielle Chiaramonte
- Department of PsychiatryYale University School of MedicineNew HavenConnecticutUSA
| | | | | | | | - Adam M. Farero
- Psychology DepartmentMichigan State UniversityEast LansingMichiganUSA
| | - Wenjuan Ma
- Center for Statistical Training and ConsultationMichigan State UniversityEast LansingMichiganUSA
| | - Cris M. Sullivan
- Psychology DepartmentMichigan State UniversityEast LansingMichiganUSA
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Corey J, Lyons J, O’Carroll A, Stafford R, Ivers JH. A Scoping Review of the Health Impact of the COVID-19 Pandemic on Persons Experiencing Homelessness in North America and Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063219. [PMID: 35328907 PMCID: PMC8954292 DOI: 10.3390/ijerph19063219] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 02/04/2023]
Abstract
Persons experiencing homelessness (PEH) are at heightened risk for infection, morbidity, and mortality from COVID-19. However, health consequences of the pandemic extend far beyond those directly caused by the virus. This scoping review aimed to explore the impacts of the COVID-19 pandemic on the health and well-being of PEH in North America and Europe. A systematic search of academic and grey literature was conducted in September 2021. To be included, studies had to include primary data related to the impact of the pandemic on health or well-being of PEH and be written in English. All potentially relevant references were independently screened by two reviewers, and minor conflicts were settled with input of a third reviewer. A total of 96 articles met criteria for inclusion. Data extraction was completed for all included studies, and findings synthesised and presented thematically. Numerous health impacts of the pandemic on PEH were identified, including SARS-CoV-2 infection, morbidity, mortality, and hospitalisation, fear of infection, access to housing, hygiene, PPE, food, as well as mental health, substance use, other health-related outcomes and treatment services. Gaps in the literature relating to persons using alcohol, access to mental health support, and violence were also identified. Implications for future research are discussed.
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Affiliation(s)
- Julia Corey
- Department of Public Health & Primary Care, School of Medicine, Trinity College Dublin, D24H74 Dublin, Ireland; (J.C.); (J.L.)
| | - James Lyons
- Department of Public Health & Primary Care, School of Medicine, Trinity College Dublin, D24H74 Dublin, Ireland; (J.C.); (J.L.)
| | | | - Richie Stafford
- HSE Community Healthcare Organisation Dublin North City & County, D09C8P5 Dublin, Ireland;
| | - Jo-Hanna Ivers
- Department of Public Health & Primary Care, School of Medicine, Trinity College Dublin, D24H74 Dublin, Ireland; (J.C.); (J.L.)
- Correspondence:
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The Unmet Rehabilitation Needs in an Inclusion Health Integrated Care Programme for Homeless Adults in Dublin, Ireland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157917. [PMID: 34360210 PMCID: PMC8345505 DOI: 10.3390/ijerph18157917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/23/2021] [Accepted: 07/06/2021] [Indexed: 11/17/2022]
Abstract
Background: People who become homeless have higher morbidity and mortality, use a disproportionate amount of healthcare resources, and generate a large volume of potentially preventable healthcare and other costs compared to more privileged individuals. Although access to rehabilitation is a human right under article 26 of the United Nations Convention on the Rights of Persons with Disabilities, the rehabilitation needs of individuals with homelessness have not been explored, and this project’s purpose was to establish a baseline of need for this cohort. Methods: A prospective audit of case discussions at an inclusion health service over a 2-month period in 2018. Results: Four multidisciplinary inclusion health clinics were observed with over 20 cases discussed in each and data were extracted using a bespoke audit data extraction tool. The inclusion health needs were diverse and complex with many unmet rehabilitation needs. Physical and cognitive rehabilitation needs were identified in over 50% of cases discussed. Musculoskeletal problems and acquired brain injuries were the most common cause of activity limitation. Most had concurrent medical conditions and addiction and/or mental health needs. None had access to rehabilitation services. Conclusion: The results of this study show that the rehabilitative needs of this cohort are significant and are not being met through traditional models of care. We are currently exploring innovative ways to provide appropriate services to these individuals.
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Vezzali L, Muldoon O. Publishing in
JCASP
: The importance of theoretical relevance and of social impact. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2021. [DOI: 10.1002/casp.2499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Loris Vezzali
- Faculty of Medicine University of Modena and Reggio Emilia Modena Italy
| | - Orla Muldoon
- Department of Psychology University of Limerick Limerick Ireland
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Dickson-Gomez J, Quinn K, McAuliffe T, Bendixen A, Ohlrich J. Placement of chronically homeless into different types of permanent supportive housing before and after a coordinated entry system: The influence of severe mental illness, substance use disorder, and dual diagnosis on housing configuration and intensity of services. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:2410-2427. [PMID: 32789923 DOI: 10.1002/jcop.22428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/05/2020] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
AIMS Permanent supportive housing (PSH) is designed to house people who experience chronic homelessness with one or more of the following: serious mental illness (SMI), substance use disorders (SUD) or human immunodeficiency virus. The Department of Housing and Urban Development has required major metropolitan areas to develop a coordinated entry system (CES) to prioritize access to PSH to those who need it the most. The aim of this paper is to determine whether PSH residents with SMI, SUD, or dual diagnosis were more likely to be housed after implementation of CES and were more likely to be housed in housing models with more intensive services provided. METHODS A cross-sectional survey with 855 residents of different PSH models. RESULTS Those with SMI, SUD, or dual diagnosis were not more likely to be housed using the CES but were more likely to be housed in higher intensity service programs. CONCLUSIONS Those with SMI are more likely to be housed in PSH with high-intensity services.
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Affiliation(s)
- Julia Dickson-Gomez
- Division of Epidemiology, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katherine Quinn
- Department of Psychiatry, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Timothy McAuliffe
- Department of Psychiatry, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Arturo Bendixen
- Division of Epidemiology, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jessica Ohlrich
- Division of Epidemiology, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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